CT abdomen and pelvis with contrast at Mount St. Mary's Hospital. CPT 74177.
What Mount St. Mary's Hospital publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$64.76cash price (self-pay)
$531list price
$57.18–$1,071range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Univera Healthcare Essential [100170] | Univera Essential Plan 3 And 4 | $109 |
| Wellpoint Bc Medicaid [351102] | Wellpoint Bc Chp Non-Medicaid [351102 | $109 |
| Amerigroup [350102] | BCBS Amerigroup Mcd [35010203] | $109 |
| Medicaid In State Alt Payer [300002] | School Medicaid Alt [30000201] | $109 |
| Medicaid Out Of State [309999] | Medicaid Michigan [30999908] | $109 |
| Medicaid Out Of State [309999] | Medicaid New Hampshire [30999911] | $109 |
| Molina Medicaid [350107] | Affinity Molina Plus (Harp) [35010703] | $109 |
| Tuscarora Nation [550120] | Tuscarora Nation Plan [55012005] | $109 |
| Wellpoint Bc Medicaid [351102] | Wellpoint Bc Medicaid [35110201] | $109 |
| Univera Healthcare Essential [100170] | Univera Essential Plan 1 And 2 | $131 |
| Univera Healthcare Essential [100170] | Univera Essential Plan 200-250 | $131 |
| United Healthcare Essential [100253] | UHC Essential 3 And 4 [10025302 | $147 |
| BCBS Essential [100152] | Bc Essential Plan 1 And 2 [10015201] | $194 |
| Wellpoint Bc Essential [101152] | Wellpoint Bc Essential Plan 3 And 4 | $206 |
| Ghi [100153] | Ghi [10015301] | $206 |
| Fidelis Essential [100163] | Fidelis Essential Plan 1 And 2 [10016301] | $227 |
| Molina Essential [100167] | Molina Essential Plan 200-250 [10016706] | $245 |
| Independent Health Essential [100166] | Iha Essential Plan 3 And 4 [10 | $270 |
| Independent Health Essential [100166] | Independent Health Essential 2 | $270 |
| Independent Health Medicaid [350106] | Medisource [35010601] | $270 |
| Independent Health Medicare [450122] | Family Choice [45012203] | $270 |
| Independent Health Medicare [450122] | Medicare PPO Iha [45012202] | $270 |
| Iha First Choice [800001] | Iha Ch First Choice Deductible Plan [80000 | $318 |
| Independent Health [100165] | Iha Passport [10016507] | $318 |
| Independent Health [100165] | Commercial Iha 44 [10016501] | $318 |
| NO FAULT [114001] | Farmers Insurance [11500104] | $385 |
| No Fault [114001] | Liberty Mutual Ins [11400108] | $385 |
| No Fault [114001] | Nationwide Ins [11400107] | $385 |
| NO FAULT [114001] | The Hartford [11500102] | $385 |
| WORKERS COMPENSATION [500101] | New York Black Car Fund [5005004] | $385 |
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